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Yr3 Met 3B > 3. Insulin, GLP-1, Ageing > Flashcards

3. Insulin, GLP-1, Ageing Flashcards

1
Q

What non-therapeutic options can be provided for Diabetes?

A
  1. Education/Information for self-management
  2. Focus on Diet/Lifestyle change
  3. Psycho/Social Support
  4. Controlling CV risk factors
  5. Regular Screening
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2
Q

How often are Diabetic patients seen per year?

A

Twice

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3
Q

What is discussed in Annual Reviews for Diabetic patients?

A
  1. Review Symptoms
  2. Review Clinical issues
    - Glucose
    - BP
    - Cholesterol
    - Albumin Creatinine Ratio
  3. Screen complications
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4
Q

What things can be targeted/changed when treating patients?

A
  1. Smoking
  2. BP
  3. Cholesterol
  4. Screening
  5. Glucose Control
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5
Q

How can we encourage diabetic patients to stop smoking?

A

1 cigarette in a Diabetic = 5 for Non-Diabetics

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6
Q

How can we adjust BP in diabetic patients?

A

FIrst Line: ACEI, CCB

  • Aim for 140/80
  • Aim for 130/80 if CVD or Renal disease
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7
Q

How can we adjust Cholesterol in diabetic patients?

A

Give a statin if:

  • Diabetic > 40
  • Diabetic < 40 BUT 1 RF

Aim for <4 mmol/L
OR LDL < 2 mmol/L

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8
Q

How can we Screen for diabetes?

A

Eyes: Digital Retinal Photography Yearly

Feet: Yearly check for Pulses and Nerves

Kidneys: Yearly ACR and eGFR (Serum creatinine)

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9
Q

What are the best ways to assess Glycemic Control?

A
  1. HbA1c: High glucose = more Hb glycation
    - Past 3 months due to RBC life
  2. Self Monitoring BG (SMBG)
    - Patients test using ia meter
    - For patients on insulin therapy
    - Pre-prandial: 4-7
    - Post-prandial: 5-9
  3. Fructosamine
    - 2 weeks
    - Used if HbA1c is shit due to Haemoglobinopathy
    - Also for Pregnancy use
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10
Q

What are the main dietary ways of treatment?

A
  1. Low in Fat/Sugar/Salt
  2. High in Fibre/Fruit/Veg
  3. 30 minutes of exercise 3x a week
  4. 3-5% weight reduction
  5. Early usage of Oral Hypo Agents
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11
Q

What are the main Medications for Hyperglycemia?

A
  1. Biguanides
  2. Sulfonylureas/ Prandial Glucose Regulators
  3. Alpha Glucosidase Inhibitors
  4. TZDs
  5. DPP-4 Inhibitors
  6. GLP-1 Analogues
  7. Insulin
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12
Q

What do Sulfonylureas and PGRs do?

A

Increase Insulin Secretion from Pancreatic Beta cells

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13
Q

What do Biguanides do?

A

Improve insulin sensitivity in the Liver and Muscle

Liver: Less Hepatic Glucose Output
Muscles/Adipose: More glucose used

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14
Q

What do Alpha Glucosidase inhibitors do?

A

They reduce intestinal glucose absorption

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15
Q

What do TZDs do?

A

They improve insulin sensitivity

Liver: Lowers Insulin resistance and Hepatic glucose production

Muscle: Lowers insulin resistance and increases glucose uptake

Pancreas: Increases Insulin secretion

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16
Q

What is GLP-1

A

31 AA Peptide (INCRETIN)

  • Secreted after a meal
  • Stimulates Insulin secretion
  • Decreases Glucagon secretion
  • Delays gastric emptying
  • Induces Satiety
  • Increases Beta cell function
17
Q

Why can the Gila monster go on for 6 months without eating?

A

Saliva makes Exendin-4 to suppress appetite

18
Q

What is Exenatide?

A

GLP-1 Analogue and Peptide

  • Suppresses Appetite
  • Stimulates Insulin release
19
Q

When can you given Exenatide?

A

BMI above 35 and poor glucose control

20
Q

Give two examples of GLP-1 Analogues

A

Exenatide
Liraglutide
Lixisenatide

21
Q

What are DPP-IV Inhibitors also known as

A

Gliptins

22
Q

How do DPP-IV inhibitors work?

A

Inhibit GLP-1 Breakdown

Increases Endogenous GLP-1

23
Q

What is the profile of Gliptins?

A

Oral
Once Daily
Well Tolerated
3rd Line Therapy

24
Q

What is the order of Diabetic Medication Line Therapies?

A
  1. Metformin
    • Sulfonylurea
    • Glitazone/Gliptin/Insulin
    • Insulin + Met + Sulfo
  5. Intensify insulin or + Glitazone
25
Q

If a patient is contraindicated for Metformin, what should you give them?

A

Sulfonylurea if not overweight

26
Q

A patient takes Sulfonylureas. What should you consider if they have an erratic lifestyle?

A

PGRs

Take Glitazones or DPP-4 if metformin is not tolerated or if hypoglycemia is an issue

27
Q

What are the main side effects of Biguanides?

A
  1. Nausea
  2. Diarrhoea
  3. Lactic Acidosis for those with Renal Failure
28
Q

What are the main side effects of PGR and Sulfonylureas?

A
  1. Hypoglycemia

2. Weight Gain

29
Q

What are the main side effects of Glitazones?

A
  1. Weight Gain
  2. Oedema
  3. Heart Failure
  4. Post menopausal fractures
  5. Bladder cancer
30
Q

What are the main side effects of Alpha-glucosidase inhibitors?

A
  1. Flatulence

2. Diarrhoea

31
Q

What are the main side effects of DPP-4 Inhibitors?

A
  1. Nasopharyngitis

2. Pancreatitis

32
Q

What are the main side effects of GLP-1 Agonists

A
  1. Nausea
  2. Diarrhoea
  3. Pancreatitis/Cancer

Yr3 Met 3B (13 decks)

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